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May is National Arthritis Awareness Month

by Dr. Yang, Jwing-Ming, May 10, 2010

According to The Arthritis Foundation, arthritis is one of the most common diseases in the United States. Rest, exercise, eating a healthy, well-balanced diet, and learning the right way to use and protect your joints are well-known keys to living with any kind of arthritis. The following is an excerpt from the book Arthritis Relief by Dr. Yang, Jwing-Ming.

Although both the Western and the Chinese systems of medicine describe arthritis in very similar ways, especially in regards to symptoms, there are a number of differences in how the two cultures approach the disease.

Western Viewpoints About Arthritis

Before discussing arthritis, we would first like to mention another popular, non-medical term, rheumatism, which is commonly confused with arthritis. Rheumatism has come to mean so many things to so many people that it is almost impossible to give it a clear definition. The term rheumatism commonly refers to any of several pathological conditions of the muscles, tendons, joints, bones, or nerves, characterized by discomfort and disability. This includes variable, shifting, painful inflammation and stiffness of the muscles, joints, or other structures.

The term arthritis is also commonly misused to refer to any vague pain in the area of the joints. However, joints are complicated mechanisms made up of ligaments, tendons, muscles, cartilage, and bursae, and pain in them can have many different causes. Arthritis is specifically an inflammation of the joints. The word arthritis is derived from the Greek words arthron (joint) and itis (inflammation). Therefore, if you have pain or swelling caused by injury to the ligaments or muscles, it is not necessarily classified as arthritis. You can see that while arthritis is (in a popular sense) a form of rheumatism, rheumatism is not necessarily arthritis.

The symptoms or characteristics of arthritis are pain, swelling, redness, heat, stiffness, and deformity in one or more joints. Arthritis may appear suddenly or gradually, and it may feel different to different people. Some patients feel a sharp, burning, or grinding pain, while others may feel a pain like a toothache. The same person may feel it at some times as pain, and at other times as stiffness. If we look more closely at these signs we can detect certain characteristic physiological changes. These changes include dilation of the blood vessels in the affected area and an increase of blood flow at the site of inflammation. In addition, there is increased permeability in these vessels, as white blood cells, that fight infection, infiltrate the diseased tissue. Finally, fluid from the blood can also leak into the tissue and generate edema or swelling. For these reasons, arthritis may affect not only the joints, but also other connective tissues of the body. These tissues include several supporting structures such as muscles, tendons, and ligaments, and the protective coverings of some internal organs.

Depending on where and how the problem started, and on what pathologic process is operating, arthritis can be classified into different forms such as gout, osteoarthritis, rheumatoid arthritis, and many others.

Chinese Viewpoints About Arthritis

Although the symptoms of arthritis remain the same everywhere, the Chinese physicians consider them from a different point of view. Like all other cases of illness, Chinese
physicians diagnose by evaluating the imbalance of Qi (which the West now calls bioelectricity) in the body, as well as by considering the actual physical symptoms.

Chinese medicine has found that, before a physical illness occurs, the Qi becomes unbalanced. If this Qi imbalance is not corrected, the physical body can be damaged and the physical symptoms of sickness will appear. The reason for this is very simple. Every cell in your body is alive, and in order to stay alive and functioning, each requires a constant supply of Qi. Whenever the supply of Qi to the cells becomes irregular (or the Qi “loses its balance”), the cells start to malfunction. Chinese physicians try to intercept the problem before there is any actual physical damage, and correct the situation with acupuncture, herbal treatments, or a number of other methods. In this way they hope to prevent physical damage, which is considered the worst stage of an illness. Once the physical body, for example an internal organ, has been damaged, it is almost impossible to make a complete recovery. This approach is the root of Chinese medicine.

Chinese physicians try to diagnose arthritis in its earliest stages, before there is any physical damage. When the Qi starts to become unbalanced, although there are no physical changes, the patient suffers from nerve pain. Because human Qi is strongly affected by the natural Qi present in clouds, moisture, and the sun (both day and night), the body’s Qi is easily disturbed by changes in the weather, and arthritis patients will usually feel pain in the joints. When cloud cover is low and there is a lot of moisture in the air, the potential of the earth’s electromagnetic field is also increased, and your body’s Qi balance can be significantly influenced. The other obvious symptom of this influence is emotional disturbance. In the West, as long as there is no symptom of physical damage, these feelings of physical and emotional pain are usually ignored, although sometimes drugs are prescribed to stop the pain.

Feng Shi or Rheumatism

Although Western physicians sometimes consider this an early stage of arthritis, Chinese physicians do not, and refer to it instead as “Feng Shi,” or “wind moisture.” This refers to the cause of the pain that the patients feel. Eastern medical dictionaries often translate “Feng Shi” as “rheumatism.”

Although countless arthritis patients regularly feel their pain worsen when the weather changes, scientists who conducted studies in an experimental climate chamber at the University of Pennsylvania concluded that there is no evidence that the weather affects arthritis. I believe that this is solely because Western medicine does not take Qi/bioelectricity into account. When Western medicine starts to understand the relationship between environmental Qi and human Qi, then ample evidence of this association will emerge.
In China, when Feng Shi occurs, people will usually seek out a physician to correct the problem through acupuncture, massage, acupressure, herbal treatment, Qigong exercises, or most commonly a combination of these methods. The specific treatment would, of course, depend upon the symptoms of each individual case. For example, if the Feng Shi stems from an old joint injury, the treatment will be different than if it were caused by weak joints. The key to treatment is finding the root of the Qi imbalance and correcting it. Only when this root cause is removed will the patient recover completely.

There are many possible causes of Feng Shi. The most common cause is a joint injury that never completely healed and caused a gradually increasing disturbance of the Qi circulation. Fortunately, if the patient practices the correct Qigong exercises, the joint can be healed completely and its strength rebuilt. Exercise stimulates the Qi and increases its circulation, which removes stagnation and blockages and lets the body’s natural healing mechanism operate. Smooth Qi circulation is the root of health and the foundation of healing.

Feng Shi will frequently also be found in patients who were born with weak joints or deformities, such as having one leg significantly longer than the other. Naturally, the most common and serious cases of Feng Shi are caused by aging. As we grow older, the muscles and tendons degenerate and start functioning less effectively around the joints, a process that places more pressure on the cartilage, synovium (joint surface), capsule, and the bones. This is the main cause of arthritis in older people.

If a person with Feng Shi does not seek to correct the problem, or the physician fails to correct it, the Feng Shi may develop into an infectious joint problem (Guan Jie Yan), which is what the Chinese call arthritis, and the joint will begin to suffer physical damage. The indications of an infectious problem are swelling, redness, pain, stiffness, sometimes fever, and deformity of the joint. This stage is already considered serious. Unlike Western medicine, traditional Chinese medicine does not differentiate among the various forms of arthritis, such as gout and osteoarthritis.

Now that you have a general idea of the different viewpoints about arthritis from both the Western medicine and Chinese medicine, we will review the structure of a joint so that you will gain a clear understanding when we discuss the different forms of arthritis.

Structure of Joints

Generally speaking, a joint is a junction where two bones meet in a way that permits each to move in relation to the other. The human body has 68 joints. Joints are made up of bones, cartilage, capsule, synovium, and ligaments. Covering the joints are tendons, muscles, and skin. Arthritis is associated mainly with cartilage, capsule, synovium, and ligaments, so we will only discuss these parts and how they function.

Cartilage
Cartilage, also called “gristle,” is a smooth, glistening, very tough, white fibrous connective tissue attached to the surfaces of bones at the joint. It is a major constituent of the fetal and young vertebrate skeleton; with maturation it is largely converted to bone. Between cartilages is an area called “joint space” or “synovial cavity.” This space contains the synovial fluid, which lubricates the cartilage and the joint space to maintain easy movement.

Capsule
The capsule is a bag or wrapping of soft tissue that surrounds the cartilage and the joint space. The capsule is usually quite loose, which allows the joint to move easily. Within the bag is a very critical structure called the “synovium.”

Synovium
The synovium or “synovial membrane” is a wet, velvety, and very delicate lining on the inner surface of the fibrous capsule. It constitutes the actual “sliding surface” of the joint. It manufactures the “synovial fluid,” which lubricates the joint, and also removes bits of foreign tissue, bacteria, and other waste matter from the joint space, absorbing them into the cells of the synovial lining and digesting them.

Ligaments
A ligament is a band or sheet of tough, firm, compact, fibrous tissue, that closely binds the related structures, such as bones, organs, fascia, or muscle together. The ligaments at the joints hold the bones together and keep them in the correct orientation to each other. Ligaments are firm rope-like structures on the outside of the joints. Collagen, a fibrous protein, is an important component of ligaments, and is also part of the structure of bones. Collagen fibers from the ligament extend into the collagen of the bone where the two meet. However, there is a sharp change in the nature of the tissue. Collagen in bone is calcified and still, while in the ligament the collagen is not calcified, so it is relatively flexible, though still firm. Usually, when an ankle is sprained, it is the ligament that is torn or damaged, often at the place where it joins the bones.

Dr. Yang, Jwing-Ming, is a renowned author and teacher of Chinese martial arts and Qigong. Born in Taiwan, he has trained and taught Taijiquan, Qigong and Chinese martial arts for over forty-five years. He is the author of over thirty books, and was elected by Inside Kung Fu magazine as one of the 10 people who has "made the greatest impact on martial arts in the past 100 years." Dr. Yang lives in Northern California.